155例肺癌患者淋巴结转移的临床研究

背景与目的胸内淋巴结(包括肺门和纵隔)转移是影响肺癌预后的重要因素之一。本研究旨在探讨原发性非小细胞肺癌胸内淋巴结转移特点及转移方式,为确定肺癌术中淋巴结清扫方式提供依据。方法按Naruke肺癌淋巴结分布图作为淋巴结清扫依据,对155例非小细胞肺癌行完全性切除及系统性淋巴结清扫术。结果155例非小细胞肺癌共清除淋巴结1553枚。总转移率为58.7%(91/155),N1占20.0%(31/155),N2占38.7%(60/155),跳跃性N2共9.7%(15/155)。肺原发肿瘤T分期与淋巴结转移之间呈线性关系。淋巴结转移率在各类型非小细胞肺癌间无差异。肺癌淋巴结可呈跳跃式纵隔转移,且区域性转移与非区域性转移均多见。结论肺癌淋巴结转移具有多组别、多区域及跳跃性特点。除临床分期为T1者外,系统性胸内淋巴结清扫在肺癌术中应常规应用。

The metastatic pattern of thoracic lymph nodes in 155 patients with lung cancer

Background and objective Intrathoracic lymph node metastasis including hilus and mediastinum is one of important prognosis factors of lung cancer. The aim of this study is to investigate the characteristics and patterns of lymph node metastasis in non-small cell lung cancer and to provide evidence for determining the range of lymph node dissection. Methods One hundred and fifty-five patients with non-small cell lung cancer received complete resection combined with systematic lymph node dissection according to the mapping system developed by Naruke. Results A total of 1553 lymph nodes were dissected from 155 lung cancer patients. The positive ratios of N1 and N2 were 20.0% (31/155) and 38.7% (60/155) respectively. Fifteen patients (9.7%) were found with skipping N2 which were located in lymph node groups 2, 4, 5, 6 and 7 respectively. There was close correlation between lymph node metastasis and T stage (P<0.01). The metastatic rate of lymph node in different histology had no significant difference. Skipping mediastinal lymphatic metastasis was found more frequently in lung cancer. Conclusion Lymph node metastasis of non-small cell lung cancer may occur in multiple groups and regions, even in a skipping pattern. Systematic lymph node dissection may be routinely performed in pulmonary resection for non-small cell lung cancer except stage T1.